MEDICARE: WALLACE W. TOWLE, OD PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	2196	AR

General Provider Information

NPI Number	:	1881183564
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WALLACE W. TOWLE, OD PA

Provider Business Mailing Address
First Line	:	PO BOX 549
Second Line	:
City	:	HOT SPRINGS
State	:	AR
Zip	:	71902-0549
Country	:	US
Telephone Number	:	501-624-5492
Fax Number	:	501-623-2242

Provider Business Practice Location Address
First Line	:	1827 CENTRAL AVE
Second Line	:
City	:	HOT SPRINGS
State	:	AR
Zip	:	71901-6848
Country	:	US
Telephone Number	:	501-624-5492
Fax Number	:	501-623-2242

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	DC YEARBY
Credential	:
Telephone Number	:	501-624-5492

Provider Enumeration Date	:	05/08/2018
Last Update Date	:	05/08/2018

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